New mammogram advice stirs discord in medical community

ST. LOUIS - A controversial health report calling mammograms unnecessary for most women younger than 50 has created a firestorm of debate by reversing years of conventional advice.

The guidelines released Monday by the U.S. Preventive Services Task Force say the harms of mammograms outweigh the benefits for younger women, and breast self exams are worthless to prevent deaths.

The panel's recommendations, which are generally respected and accepted by medical schools, doctors and insurance companies, were met with outrage from some health care organizations.

The American College of Radiology, which represents doctors who perform and analyze mammograms, said the recommendations could lead to "countless unnecessary breast cancer deaths."

"To me it sounds like they're taking women under the age of 50 and saying, 'We're not going to teach you to do breast exams. We're not going to screen you. So if you get it, sorry, tough, you're dead,' " said Dr. Catherine Beal, a radiologist at St. Anthony's Medical Center in St. Louis.

Most medical organizations still call for all women 40 and older to receive annual mammograms.

Beal said she doesn't agree that the risk of false positives, over-diagnosis and unnecessary treatments outweighs any benefit from the X-ray screenings.

"Yes there is anxiety, but are you telling me women aren't strong enough to take that, in exchange for diagnosing breast cancer early and saving their life?"

But some cancer advocacy groups welcomed the task force's recommendations as an acknowledgment of the imperfections of screenings and a starting point for more nuanced research into cancer prevention and treatments.

The National Breast Cancer Coalition put out a statement saying "mammography screening has significant limitations and should be a personal choice rather than a public health message."

Other doctors and patients said the new guidelines raised questions about the task force and its methods.

The U.S. Preventive Services Task Force is an independent panel of experts created 25 years ago by Congress to regularly review the benefits of cancer screenings and other preventive medical care.

Its mammogram recommendations are not the first to start a debate. Last year, the task force updated its guidelines on prostate cancer by not endorsing universal screenings and recommending against them for men older than 75.

The panel's decisions are based on reviews of scientific data and evidence. Insurance, costs and other financial issues are not taken into consideration.

For mammograms, the task force looked at mathematical models to determine what would happen if women were screened at different ages and time intervals.

"We're not looking at the politics, we're not looking at insurance coverage, we're not rationing care," said Dr. Michael LeFevre, professor of family and community medicine at the University of Missouri-Columbia, who has served on the task force for five years. He is the only representative from Missouri or Illinois.

"We're looking at whether the benefit to patients outweighs the harms."

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The recommendations made by the task force are aimed at a general and healthy public, not people at high risk for certain diseases. Panel members have said their guidelines should be a starting point for conversations between patients and doctors.

Along with LeFevre, the 16-member committee is made up of other family physicians, gynecologists, nurses and pediatricians who work in hospitals around the country.

Most of their recommendations, for everything from cholesterol checks to hearing tests, are updated every five years based on new information.

LeFevre was nominated to the committee by the American Academy of Family Physicians. Task force members typically stay on for four years but there is no upper limit.

Each member of the panel serves on the committee as a volunteer. They meet three times a year in Washington and spend many more hours on their own reviewing research and data.

"Everybody does it because they think it's important work and it serves the community to have evidence-based recommendations available," LeFevre said.

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RECOMMENDED HEALTH SCREENINGS AND TESTS:

The U.S. Preventive Services Task Force is a committee of medical experts who make recommendations on disease screenings and tests. Here's a sampling of their findings:

-Cholesterol tests: Strongly recommended for all men 35 and older and women 45 years and older with a risk of heart disease. Tests can be taken every five years or longer depending on risk factors.